Abstract
Introduction
Anterior discectomy and spinal fusion have had acceptable surgical results, but many complications have been reported, especially adjacent segment degeneration and bone graft complications. To compare the surgical results of laminoplasty with those of anterior spinal fusion in patients with myelopathy caused by the cervical disc herniation, and to make a treatment strategy for cervical disc herniation depending on these results.
Patients and Methods
A total of 10 patients with cervical disc herniation were examined in this study, who underwent laminoplasty without resection of the herniated disc. The mean age was 60 years. As a control group, 31 patients (mean age, 53.4 years) who underwent anterior spinal fusion were examined. All patients in the laminoplasty group also had developmental spinal canal stenosis in which the anteroposterior canal diameter was less than 13 mm. The mean follow-up was 2.5 years in the laminoplasty group and 3.2 years in the anterior fusion group. Neurological and radiological results were examined. The severity of myelopathy was evaluated according to the Neurosurgical Cervical Spine Score (NCSS). Surgical outcomes were evaluated by the NCSS for determining the recovery rate.
Results
The recovery rate averaged 46% in laminoplasty and 48% in anterior spinal fusion. There were no significant differences between the groups. Cervical lordosis angle was diminished postoperatively without a significant difference between the two groups. In the laminoplasty group, one patient with kyphotic deformity after laminoplasty had transient motor weakness, and one patient underwent anterior spinal fusion after laminoplasty according to myelopathy caused by the cervical disc herniation. Follow-up magnetic resonance imaging showed regression of the size of the herniated disc in 5 of the 10 patients in the laminoplasty group.
Conclusion
Laminoplasty for patients with narrowed spinal canals showed favorable surgical results. Laminoplasty should be employed for cervical myelopathy caused by disc herniation in particular with developmental spinal canal stenosis to avoid secondary myelopathy.